Saturday, January 26, 2013

Learning to act my age, about time surely?


This week I have been mostly realizing that I need to start acting my age, not my shoe size.  I don’t mean all the time; sometimes there’s nothing better than behaving like a kid! But, on the flip side, there are plenty of times when, as an adult, you need to step up and take responsibility. I am not very good at doing this! A number of examples have arisen this week; I will share the diabetes one.

This week, in diabetes terms, wasn’t great. I keep on getting confused and making mistakes with my dosing, something that can be rectified by writing them down. But the thing that triggered this post was my eating pattern. I have been hypoing after school and have been consistently over-treating, using the hypoes as an excuse to eat a whole load of stuff that I know I shouldn’t treat low blood sugar with: chocolate mainly. Chocolate is high in fat and the fat slows down the absorption of the carbs. The best thing to treat hypoes with (for me, anyway) is fruit juice, one carton has just the right amount of sugar to raise my blood sugar levels without causing a huge spike, and because it’s liquid it’s absorbed quickly. The thing is, when I am feeling hypoey, my body screams at me for sugar. This leads to a raid of the cupboards and a subsequent binge on anything remotely sugary. I know for a fact that this is a scientific thing, but it doesn’t change the fact that it’s bad for me. Afterwards I feel guilty, about my blood sugars and the amount of food I’ve eaten; I get angry with myself and then invariable take it out on poor J. I also end up with a stratospherically high reading before dinner. This in turn means I have to take a larger dose of insulin with dinner and means I’m struggling to figure out my dinnertime ratios and my overnight basal dose.

I have gotten away with a lot in my life and I don’t think I truly appreciated this until now. As a kid I think I was pretty normal, but then once I had been diagnosed with diabetes everything changed. I mean, of course it did! It was traumatic for me, and for those around me. And the people around me all dealt with it in different ways. I remember visitors when I was in hospital: some were fascinated by the needles and the blood tests; others were horrified (one nearly fainted!); and some I don’t really remember at all. And the reactions, of course, didn’t stop. Now, most people ask lots of questions. Some hone in on the injections, “I could NEVER do that!” Strangers often stare when they see me do a blood test of inject. But among people I talk to there is a common theme of pity: comments about how hard it must be. And yes, it is hard. But equally, it shouldn’t be an excuse for my bad behaviour, which I think it evolved into fairly quickly. Now I know that some of you reading this will tell me off for being hard on myself, but I’m trying not trying to tear myself to pieces, I am trying to be constructively critical. For so many years I have not taken my diabetes seriously. And even now, when I really do try to take it seriously, I still cannot do the things that I know I need to to live a healthy life. Things like eating sensibly, exercising and making changes to my daily diabetes routines. But the thing is, not doing them just leads to me feeling bad about myself and behaving like a spoilt child.

The problem is, I’m no longer a child. There comes a point where excuses need to stop and responsibility needs to start. I am coming to terms with this far too late.


Thursday, January 24, 2013

A little mid-week excitement!

A very brief (and unusual!) mid-week post... Special times call for special measures!

This morning, I called Philadelphia. Not on my usual list of things to do at 06:10 on a Thursday. I called Philadelphia to set up a 'Visit' with Dr. Scheiner, the author of the book I so recently discovered.

On further exploration of his website, I found a page dedicated to Type one diabetics with a blurb about 'Intensive Diabetes Care'. I decided to find out more so a week or so ago I emailed and received an email reply within 24 hours saying that I was welcome to call and make an appointment. Which I did. This morning. I have an appointment on February 5th. Eek!


To say I'm excited is an understatement. I mean, I know that ultimately it's down to me to do the day-to-day stuff. However, having some expert support, I hope, will make some difference. It has to, surely? The day-to-day stuff is tricky. And this week I've been slowly recovering from my sniffles and my body seems to be in hibernation mode: each evening I have been stuffing myself with food... Not good for me or my blood sugars. And I know that only I can change this. But: bring on a little knowledge to help me with the science bit!

Update and analysis on Sunday...

Sunday, January 20, 2013

Week 2 (13/1/13 - 19/1/13)

Today, at around 2pm, I emerged from what can only be described as a dense fog. A fog which had increasingly descended on me as the week went on. I had a bad week. A bad week diabetes-wise, a not-so-great week work-wise and and pretty yucky week otherwise.

I have just completed and posted this week's analysis, and it's lucky that the fog had already cleared or it would've descended further looking at the numbers I've just crunched!

So, this week, I have had just 25.65% of readings in range. Significantly worse that last week. But, looking back now with a somewhat clear head, I have 2 and a half explanations to at least try to account for some of it. But a warning: those of you who don't want to know about my menstrual cycles need to stop reading here... Those of you who aren't fussed - for medical purposes obviously! - you may continue...

Explanation 1: This weekend I have been ill.. Not really, seriously, life-threateningly ill, but I have had a very sore throat and and what I call the 'sniffles'. Other than being incredibly tired, I didn't feel ill until Friday; funnily enough the time when my blood sugars started behaving better. The thing about illness is that, as a diabetic, your body actually often ends up making you sicker. If your blood sugar levels are high your white blood cells don't fight  infection as well as they should, extra sugar in your blood also helps to feed the viruses or bacteria that are causing the infection and to top it off stress hormones, which are produced when you are ill make insulin less effective. This all adds up to higher blood sugars which exacerbate the whole process. In short, my body has spent, I'm guessing, the majority of the week trying to fight off an infection. Which wouldn't have been so bad if the week hadn't started off so badly in terms of high levels...

Explanation 2: The reason my blood sugars were so high (I think!) at the beginning of the week was because every month, in the days before that-time-of-the-month my blood sugars sky-rocket. This is apparently due to hormones (isn't everything?!) which prevent insulin working as well as it should. As soon as I actually get my period everything seems to settle down; as if by magic, my morning blood sugar suddenly fell yesterday morning and stayed fallen this morning.

Explanation 2.5: Stress. This week has been a tricky one work-wise. Stress is a pain in the butt. It's silent. It's unpredictable. And it affects insulin absorption. Brilliant!

This is why I am writing week 2 off to experience. I am going to wait and see what happens this week. I am going to keep the changes I made the previous week and see if, without all the other hurdles, it's slightly more plain sailing. I will have to wait until next month to see if my hypotheses are correct.

Saturday, January 12, 2013

Week 1 (7/01/13 - 12/01/13)


So, I'm finally starting to get my head around how I can use this space meaningfully.

Today, I have analysed last week's blood sugar readings, as planned, and thought about some changes to make for week 2's efforts. I have set up 2 more pages for my blog: a page to record my learnings as I go, and a page to log my weekly analyses. Whether anyone but me will ever read them is immaterial; I'm just hoping it will help me gain more insight into my fluctuations! However, if anyone DOES fancy reading them and putting their two-pence in I will be very grateful as my perspective is, of course, subjectively skewed.

Week 1 then... Overall, my readings were too high; I knew this before I analysed them. I was actually quite surprised that nearly 40% of them were in range. Now I am aware that this is nowhere near large enough as  a percentage, but it's a starting point that is not as near 0 as I would have anticipated. That said, nearly 60% of my readings were too high. That needs to change. Ideally, I am ultimately aiming for no more than 25% of my readings to be higher than my ideal range. Next week, my target is 50%: baby steps.

317 (17.6 in old money) for my highest reading is way too high. However, I only had 1 hypo, which for a back-to-work week is pretty darn good. I need to work on reducing the gap between my highest reading and lowest reading.

Looking at the spread of my results over the days of the week was quite interesting (to me!!) I noticed high mornings, a mixture of before lunch readings, lows after school and a mix at bedtime. To make it manageable for week 2, I am going to set myself the following targets:

  1. To test before bed, every night, and on waking to try and figure out my overnight basal dosage.
  2. Try to avoid snacks at breaktime (for now) to see the effect on my pre-lunch levels; last week I found even having something with technically no carbohydrates (e.g. a carrot and some tomatoes) made my pre-lunch levels higher than the days I had no snack.
  3. To decrease my lunchtime insulin ratio from 0.18:1 to 0.15:1 to try and curb the after school dip.
Let's see how this goes...




Thursday, January 10, 2013

New Year's Resolutions, and all that Jazz!


This morning I had a small, but miraculous, breakthrough! But before I share it I will explain its birth.

As per usual, with the start of a new year, my brain went into New Year’s Resolution over drive. I am that person, every year without fail, who vows to improve every last detail of themselves: mind, body and soul. Needless to say that by January 4th I have fallen off the wagon spectacularly. So this year I decided to try and be a little more resolution-savvy. And so far so good: it’s January 10th and I’m still strapped in!

My first resolution has had a fairly obvious, but not immediately to me, effect on the second.
1.     To turn off electronic items at 9:00pm
2.     To record my blood sugars, on paper, every day.

The first I decided on as I am always exhausted. This is partly, admittedly, down to my badly-controlled sugar levels, but it’s also due to the fact that I am just very bad at relaxing, I can’t for the life of me switch off. Ever. So reading an article in Zest magazine (I am an avid reader in spite of the fact I barely ever exercise!) and then a similar article in My Diabetes Digital (an electronic diabetes magazine I have just discovered) about the benefits of not over-stimulating your brain before bed, I decided to give it a whirl. So far, the biggest side-effects have been a) scarily vivid dreams (is that a good sign or a bad sign?!) and b) a general attitude towards trying to have a more healthy outlook on life. The latter has, in turn, led to the somewhat knee-jerk reaction of deciding to leave school at a decent time each night. The chain reaction continues… It turns out that leaving school before sunset has quite a positive impact, not only on my board game prowess, but also on my sugar levels…

I mentioned in my last post that I was reading a book by (my new guru) Dr. Gary Scheiner, Think Like a Pancreas. While I haven’t actually read much more it has unwittingly turned into my bible. My second resolution came from statistics quoted in the book (Ok, so not really statistics, more like subjective jargon, but still…): “It’s a fact: people who keep written records have better glucose control than those who don’t.” To be fair, the guy is a doctor… And it was enough to inspire me. According to Scheiner, “successful diabetes management requires proper tools, self-care skills and the right attitude. One or two out of three won’t cut it – all three are necessary.” And the more I think about it, the more I’m inclined to agree.

The first of these I have: a fairly decent set of tools, i.e. a blood glucose meter and insulin pens, a medical team that tries to be helpful, a magical app that saves my brain from calculating ratios every time I eat. I hope, soon, to add a pump to this list. The others were somewhat lacking. I made the assumption that inputting my data and printing it off before my appointments were sufficient to help me keep afloat. It turns out they’re not. When I initially read Dr. Scheiner’s comments about record-keeping (“If you’re sitting there saying, ‘No need. I can just download my thingamabob to the computer. It keeps all the information for me.’ Sorry, bud. At this point there is no good replacement for written record-keeping system.”) I all but sneered. Yeah right. Why would writing stuff down make the least bit of difference? Well. It would seem it does. So why have I been so keen not to do it all my diabetic life?! Why did I not see this before?

It turns out that writing the numbers down, with a pen on paper, works like magic, if you actually do it. And, funnily enough, getting home at a decent hour has a startlingly positive impact on my attitude towards doing this. Who would’ve thought..? Anyway, I started my resolution early, at the end of term last year but in true me-style, couldn’t quite get my arse into gear until the new year was officially upon me. Since then, I have gone through a what’s-the-point-there’s-nothing-to-see-here-phase to this morning’s epiphany.

I have been recording my levels using a daily logsheet adapted from one that Scheiner provided in The Book. Initially I was just getting disheartened. The numbers were all too high and the patterns, over night especially just seemed non-existent. It was then I decided to return to The Book’s guidelines for Fine-Tuning Injected Basal (long-acting or baseline insulin) Doses, paraphrased below:
1.     Have a fairly low-fat dinner and take insulin.
2.     Test blood 3 hours after dinner. If >80 and <250 continue with experiment.
3.     Check blood in the middle of the night and first thing in the morning.

For the first few nights back in Korea, I couldn’t bring myself to set an alarm for 3am. So I made do with toilet-trips when they occurred.

Night one
Before bed: 78
4:30am: 98
Waking: 162
An overall rise of 84mg/dL. Not too hot.

Night two
Before bed: 125 (perfect!)
4:00am: 288 (at which point in injected 4 units of insulin)
Waking: 122 (perfect!)
Without the 4:00am test and insulin, I would have woken up sky-high. As it stands, with the correction dose, my levels were perfect.

Night three
Before bed: 136 (pretty good)
2:30am (with an alarm, which surged adrenaline through my body and made me drop my testing paraphernalia all over the bathroom floor!): 77 – far too low! I had a carton of mango juice.
Waking: 113 (perfect!)

So. The mystery of my erratic overnight blood sugars may, for now at least, be partially solved. Last night’s readings show a dip that shouldn’t be there. So tonight I am going to adjust my basal dose accordingly, by decreasing it by 10%, and see what good that does.

The third of Dr. Scheiner’s top diabetes tips I am currently working on: the right attitude.  This, apparently, consists of: determination, problem solving, persistence, discipline and acceptance. I’ve still got a fair go with that one. Did I say that I was NOT trying to improve every last detail of myself. Maybe I was a little hasty… So while I wait for the angel’s halo to be delivered along with my recently-ordered Carcassone Extension pack (to help bolster the board game prowess further!) I am left repeating Scheiner’s serenity prayer (slightly hysterically): Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.